Provider Demographics
NPI:1700467610
Name:LOVELESS, KATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:RIO DELL
Mailing Address - State:CA
Mailing Address - Zip Code:95562-0241
Mailing Address - Country:US
Mailing Address - Phone:707-296-6877
Mailing Address - Fax:
Practice Address - Street 1:1100 MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2148
Practice Address - Country:US
Practice Address - Phone:707-497-8744
Practice Address - Fax:707-861-6102
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical